Shrestha, Nipun (2020) Increasing Physical Activity and Reducing Sedentary Behaviour in Mental Health Professionals. PhD thesis, Victoria University.

Abstract

Clinicians with a high level of physical activity (PA) are more likely to recommend PA to their clients, compared with those with a low level of PA. Interventions to increase PA and reduce sedentary behaviour (SB) among mental health professionals may, therefore, indirectly benefit their clients with mental disorders. However, there is limited evidence on the effectiveness of interventions aimed at increasing PA and reducing SB among mental health professionals in changing their attitudes towards and practices in recommending more PA and less SB to their clients. Therefore, four studies were conducted as a part of this PhD thesis, to address this overarching research question. A critical evaluation of interventions for increasing PA (Chapter 4) and systematic reviews and meta-analyses of interventions for reducing SB (Studies 1 and 2) provided information about the effectiveness of various PA and SB interventions among adults. The literature identified that for PA promotion, there is evidence on the short-term effectiveness of interventions based on counseling/support, and health promotion messages/information, but evidence on the long-term effectiveness of these interventions is limited. The systematic reviews also found that the use of sit-stand desks at work, restricting the use of TV devices in leisure time, and educational interventions outside workplace were effective strategies in reducing SB in the short term, however evidence on the effectiveness of these interventions in the long term is limited. Digital interventions, such as a prompts on the computer screen, and the use of wearable devices were found to be increasingly popular interventions for increasing PA and reducing SB. Evidence on the effectiveness of PA and SB interventions specifically among mental health professionals is scarce, but it can be assumed that most of the interventions that are effective in the general population of adults will also be effective among mental health professionals. Study 3 explored attitudes and practices of mental health professionals in recommending more PA and less SB to their clients. Data were collected using a modified Exercise in Mental Illness Questionnaire in a sample of 17 Australian mental health professionals. Additionally, in focus group discussions, 10 mental health professionals provided in-depth information about their practices, facilitators, and perceived barriers in recommending more PA and less SB. It was found that PA and SB counselling in the mental health setting could be improved by: including training on PA and SB counselling in formal education and continued professional training for mental health professionals; implementing interventions to increase PA and reduce SB among mental health professionals themselves; and ensuring support from an exercise or PA promotion specialist as a part of a multi-disciplinary approach to mental health care. Study 4 investigated the effects of an intervention designed to increase PA and reduce SB among mental health professionals on their attitudes towards and practices in recommending more PA and less SB to their clients. The intervention was informed by the findings of the Chapter 4, Study 1 and Study 2, and it consisted of a single group-based behaviour change session, which included a presentation of various strategies to increase PA and reduce SB and goal setting according to the SMART goals approach. An information booklet containing 24 strategies to increase PA and reduce SB was also provided to the participants. They also received reminder texts/calls during the following three weeks of the intervention. There was no significant overall change in PA and SB among mental health professionals, but the intervention had a positive effect on their attitudes towards recommending more PA and less SB to their clients. The mental health professionals who increased their own PA during the intervention (compared to those who did not) significantly increased the frequency of recommending more PA (p= 0.009) and less SB (p= 0.005) to their clients. Two post-intervention focus group discussions with the participants suggested that the intervention positively influenced their confidence in recommending more PA and less SB to their clients and provided them with pragmatic strategies to include in their practice. The findings of the studies included in this thesis suggest that a relatively simple intervention has the potential to improve mental health professionals’ attitudes towards and practices in recommending more PA and less SB to their clients. The intervention could be scaled up to promote more PA and less SB within mental health settings, with potential benefits for mental health professionals and their clients.

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